The cardinal funduscopic feature of malignant hypertension is optic disk swelling (seen in both images), which appears as blurring and elevation of disk margins. The top image also shows a characteristic star-shaped macular lesion caused by leaking retinal vessels. The bottom image also shows a characteristic flame-shaped hemorrhage and dilated veins.

Images courtesy of Prof. J. Wollensak (top) and the Ophthalmic Clinic of the Health Center of the University of Erlangen-Nürnberg (bottom), via the Online Journal of Ophthalmology (www.onjoph.org).